MINNEAPOLIS, May 8, 2008—MMA members were apprised of the status of the association's health care reform efforts in this letter, sent late Wednesday afternoon: 

May 8, 2008

Dear MMA members:

Re: End Game’s On for Health Care Reform

The MMA’s top priority this year is health care reform – bringing the Physicians’ Plan for a Healthy Minnesota, proposed in 2005, closer to reality.  Now in the final days of session, success on many of our reform goals is close, but not certain. The situation at the Capitol, which has fluctuated wildly throughout session, still remains fluid.

Throughout the legislative session, MMA lobbyists have been at the Capitol every day, talking to key legislators, working on behalf of MMA members and their patients. 

Wins ?– Medical Homes and Public Health
We’re optimistic that reform will include these aspects of the MMA’s plan:

• Medical homes - Voluntary certification and payment for care coordination, a key reform component focused principally on patients with complex, chronic conditions that will provide resources to physicians to support a patient-centered approach to care delivery that can coordinate care and improve patient decision-making;
• Primary prevention/public health initiatives- – State investment in programs to reduce tobacco use, alcohol abuse, obesity, and illegal drug use.

Dodged bullets ? – A Return to Capitation (also known as “Level 3”)
We’re hopeful, but not yet certain, that the MMA has successfully blocked attempts to turn physicians into insurance providers and risk managers by making them accountable for the “total cost and quality of care.” 

When a payment scheme called Level 3 was first proposed in January, the MMA quickly voiced strong opposition and has continued to do so throughout the legislative session.  MMA members have responded to Action Alerts and joined MMA lobbyists and leaders in telling lawmakers that it’s a step backward to capitation, a model that has been tried and failed. 

The MMA has met with key legislators, public officials, and the governor’s staff, and has testified before committees and distributed letters to lawmakers, warning that theimplications of this proposal for the varied types, sizes, and geographic locations of Minnesota medical practices are unknown but could be dramatic, including a rush to even greater consolidation.

As the conference committee meets to come up with a final bill to send to the House and Senate floors, the Senate bill still includes Level 3, but the House bill does not.  Instead it includes a voluntary option for providers to establish package prices for a limited number of services that would yield some flexibility in payments so that providers could innovate on care delivery, a compromise amendment that was worked out between House legislative leaders and MMA leaders and lobbyists. 

In recent weeks, the MMA has worked closely with health department staff to develop language that would bridge the divide between the House and Senate proposals.  The intent of MMA has been clear – to eliminate a dictate for a one-size-fits-all payment model like Level 3 that would have physicians bear financial risk for total cost and quality (as found in the Senate bill), while allowing the opportunity for payment reform that supports innovations in care delivery and that begins to address the visit and volume-driven incentives inherent in most payment models today. 

Following these conversations, the Governor has added momentum to our efforts to derail Level 3 by proposing language that would eliminate Level 3 and  instead focus efforts on collecting data to develop transparent measures of the cost and quality of care.  The MMA, which has added language to address key methodological issues and processes, supports this approach.

The situation remains in flux and likely will continue to change until session ends on May 19th.  Watch the MMA website and read the email newsletter for the latest developments.

Questions
A cornerstone of the MMA’s health care reform plan is health insurance for all Minnesotans.  It is still not clear whether eligibility will be expanded for state programs, which would move us closer to that goal. Discussions about eligibility will be part of larger budget negotiations. The MMA continues to urge lawmakers to work toward universal health care coverage. 

In a surprising last-minute proposal, the governor has called for a “private entity or consortium of private entities,” to implement health care reform instead of a new Health Care Transformation Commission. The MMA is urging conferees to make sure that this entity will be “credible, accountable, transparent, inclusive and adequately funded.”  It definitely must include practicing physicians representing differing practice styles.

You’re Invited to Comment
Do you have comments or questions about MMA’s health care reform activities or the current situation at the Legislature?  Please let us know.  Email: rmeiches@mnmed.org.

More Information

• Read a timeline of the past 5 months' events as the MMA worked on your behalf on health care reform.
• Review the MMA’s Physicians’ Plan for a Healthy Minnesota calling for health insurance for all Minnesotans, a strong public health system emphasizing disease prevention, systems that support high quality health care, and a health care delivery market focused on value.
  Read the letter the MMA submitted to the conference committee outlining the MMA’s positions on various aspects of the House and Senate health care reform bills.
• Go to the Health Care Reform Key Issues page of www.MMAonline.net and read all about it